Antibiotic Adverse Reactions and Drug Interactions
Section snippets
Anaphylaxis
Anaphylaxis is an acute hypersensitivity reaction that can result in immediate urticaria, laryngospasm, bronchospasm, hypotension, and death. In the critical care setting, these reactions may be masked by underlying conditions or other therapies. While anaphylaxis can be precipitated by antigen-antibody complexes, it is usually IgE mediated. The binding of antibiotic epitopes to specific preformed IgE antibodies on the surface of mast cells results in the release of histamine and other
Drug interactions
The remainder of this article discusses important potential interactions amongst antibiotics and between antibiotics and other medications. Antibiotics can either be the precipitant or the object of a drug interaction. Interactions can be beneficial or harmful. This section addresses beneficial interactions before focusing on interactions that can result in adverse events.
Summary
Antibiotics are commonly used in the ICU. Adverse effects are regularly encountered and must be anticipated. The multiplicity of medications and underlying conditions in ICU patients affect the presentation and management of adverse reactions. When possible, the intensivist should employ the fewest number of antibiotics necessary, choosing those least likely to interact with other drugs and cause adverse reactions.
Acknowledgments
The authors gratefully acknowledge intensivists Lori Circeo, Thomas Higgins, Paul Jodka, and especially Gary Tereso for helping us identify the most important adverse reactions and drug interactions affecting critically ill patients. The authors also gratefully acknowledge Pauline Blair for her excellent assistance in preparing this review.
References (117)
- et al.
Diagnosis and management of penicillin allergy
Mayo Clin Proc
(2005) - et al.
Imipenem cross-reactivity with penicillin in humans
J Allergy Clin Immunol
(1988) - et al.
Drug-induced Q-T prolongation
Med Clin North Am
(2005) - et al.
Adverse effects of vancomycin administered in the perioperative period
Mayo Clin Proc
(1986) - et al.
Risk factors for amphotericin B-associated nephrotoxicity
Am J Med
(1989) - et al.
Amphotericin B nephrotoxicity in humans decreased by salt repletion
Am J Med
(1983) - et al.
β-Lactam antibiotic-induced leukopenia in severe hepatic dysfunction: risk factors and implications for dosing patients with liver disease
Am J Med
(1993) - et al.
Vancomycin-induced neutropenia
Lancet
(1981) N-methyl-thio-tetrazole inhibition of the gamma carboxylation of glutamic acid: possible mechanism for antibiotic-associated hypoprothrombinemia
Lancet
(1983)- et al.
Ototoxicity with azithromycin
Lancet
(1994)
Fever in the intensive care unit
Infect Dis Clin North Am
Fever in hospitalized patients
Am J Med
Fever of nosocomial origin: etiology, risk factors, and outcomes
Am J Med
Extraintestinal Clostridium difficile: 10 years' experience at a tertiary-care hospital
Mayo Clin Proc
Clostridium difficile infection in patients with unexplained leukocytosis
Am J Med
Acute abdomen as the first presentation of pseudomembranous colitis
Gastroenterology
Does combination antimicrobial therapy reduce mortality in gram-negative bacteraemia? A meta-analysis
Lancet
Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies
JAMA
Unique aspects of antimicrobial use in older adults
Clin Infect Dis
HIV and drug allergy
Curr Opin Allergy Clin Immunol
Antibiotic usage in an intensive care unit in a Danish university hospital
J Antimicrob Chemother
The prevalence of nosocomial infections in intensive care units in Europe
JAMA
Nature and extent of penicillin side-reactions with particular reference to fatalities from anaphylactic shock
Bull World Health Organ
Immediate hypersensitivity reactions to beta-lactam antibiotics
Ann Intern Med
Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy
JAMA
Cephalosporin allergy
N Engl J Med
Is there cross-reactivity between penicillins and cephalosporins?
Am J Med
Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy
Clin Infect Dis
Imipenem in patients with immediate hypersensitivity to penicillins
N Engl J Med
Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins
Ann Intern Med
Oral erythromycin and the risk of sudden death from cardiac causes
N Engl J Med
Vancomycin and cardiac arrest
Ann Intern Med
Amphotericin B revisited: reassessment of nephrotoxicity
Am J Med
Acute renal failure in critically ill patients. A multinational, multicenter study
JAMA
Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin
N Engl J Med
Controlled comparison of gentamicin and tobramycin nephrotoxicity
Am J Nephrol
A model for predicting nephrotoxicity in patients treated with aminoglycosides
J Infect Dis
Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis
Ann Intern Med
Single or multiple daily doses of aminoglycosides: a meta-analysis
BMJ
Amphotericin B: 30 years of clinical experience
Rev Infect Dis
Amphotericin B nephrotoxicity with irreversible renal failure
Arch Intern Med
Renal failure and interstitial nephritis due to penicillin and methicillin
N Engl J Med
Drug-induced acute interstitial nephritis
Ren Fail
Linezolid and reversible myelosuppression
JAMA
Linezolid for the treatment of multidrug resistant, gram-positive infections: experience from a compassionate-use program
Clin Infect Dis
Mechanisms for linezolid-induced anemia and thrombocytopenia
Ann Pharmacother
Statewide study of chloramphenicol therapy and fatal aplastic anemia
JAMA
Anti-infective drug use in relation to the risk of agranulocytosis and aplastic anemia: a report from the International Agranulocytosis and Aplastic Anemia Study
Arch Intern Med
Antibiotic-induced agranulocytosis: a monocentric study of 21 cases
Arch Intern Med
Inhibition of granulopoiesis in vivo and in vitro by β-lactam antibiotics
J Infect Dis
Cited by (0)
This article was adapted from Granowitz EV, Brown RB. Adverse reactions to antibiotics. In: Cunha BA, editor. Infectious diseases in critical care medicine, 2nd edition. New York: Informa Healthcare USA, Inc.; 2007. p. 575–94; with permission.
- 1
Dr. Brown is on speakers' bureaus of Merck, Ortho, Pfizer, and Cubist pharmaceuticals.